Tackling COVID-19 in informal settlements in Cape Town


CAPE Town is the second-largest city in South Africa, with a population of over 4 million people. It is a diverse and complex city, with a long history of segregation and inequity, the most tangible manifestation of which is its dense informal settlements without adequate housing or basic infrastructure.

Estimates of the number of households that live in informal settlements differ, but one estimate is that there are about 146,000 households living in informal settlements in Cape Town. Informal settlements are settlements in which residents do not have legal security of tenure and do not have dwellings that comply with planning and building regulations, and which therefore generally lack adequate services.

Cape Town has been the most-affected African city in terms of COVID-19 so far. As of 6th July 2020, there had been about 50,000 cases of COVID-19 in the city.

The highest prevalence of COVID-19 is found in the two districts with the highest concentrations of informal housing: Khayelitsha (6,721 cases in an area with a population of about 400,000 people) and Klipfontein (6,428 cases in an area with a population of about 380,000 people).

These two districts have prevalence rates of over 1,600 cases per 100,000 people, compared with Cape Town’s current average prevalence of 1,174 cases per 100,000 people.    

The reasons for the higher prevalence of COVID-19 in areas of informal housing is that residents of informal settlements are particularly at risk of infectious diseases as it is difficult to practice social distancing in overcrowded conditions, and the lack of adequate water supply and sanitation means that practising good hygiene practices is extremely difficult.

These concentrations of informal housing have limited access to economic opportunities, limited opportunities for safe physical activity and healthy food options, and high levels of depression and stress. The net result is that the environment of these areas is not conducive to good health or healthy lifestyles.

The link between the inadequate living conditions in informal settlements and the health of residents has been long recognised, but actually improving conditions in informal settlements has been challenging, because of issues such as high densities, overcrowding, shortage of affordable well-located vacant land, insecure livelihoods and complex migratory patterns.

There have been many attempts to address COVID-19 in informal settlements. Testing in Cape Town has been concentrated in informal housing areas and other “hotspots”.

In April 2020, the National Minister of Human Settlements, Water and Sanitation announced plans to fast track the provision of temporary water and sanitation services in informal settlements, and also indicated an intention to “de-densify” informal settlements by “relocating and decanting” people from the densest settlements to other sites.

A number of informal settlements, including Dunoon in Cape Town, were subsequently announced as being due for relocation. In Cape Town, plans are currently underway for the relocation of 3,500 informal settlement households.

Public health regulations have frequently been used to demolish “slums” and relocate residents in the name of better health, and the danger is that COVID-19 will be used as a motivation for demolishing informal settlements and relocating residents.

In some cases relocations to nearby sites may be necessary to reduce overcrowding, but in many cases, relocated residents may end up worse off, much further away from employment opportunities and facilities, and with their social networks severely disrupted.

There are, of course, many reasons why informal settlements should be upgraded, but the COVID-19 pandemic highlights the urgency of upgrading informal settlements so as to reduce the risk of infectious disease in these high-risk areas.

Processes to upgrade informal settlements and provide residents with sufficient amounts of sufficient living space and adequate services need to be participatory, with a range of accompanying social and economic development programmes to improve people’s lives and reduce their vulnerability to risks.

It is important to reduce overcrowding through these upgrading processes, but this could be done through the provision of multi-storey housing, there do not necessarily need to be large-scale relocations of residents. – Thomson Reuters Foundation.

  • Warren Smit has been a researcher on urban issues since 1993. He is currently Research Manager at the African Centre on Cities at the University of Cape Town.  He manages ACC’s health research stream in the international research project PEAK Urban

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